This study examined factors associated with emergency department use among homeless and marginally housed persons.
Interviews were conducted with 2578 homeless and marginally housed persons, and ...factors associated with different patterns of emergency department use were assessed in multivariate models.
Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% exhibited high rates of use (more than 3 visits) and accounted for 54.5% of all visits. Factors associated with high use rates included less stable housing, victimization, arrests, physical and mental illness, and substance abuse. Predisposing and need factors appeared to drive emergency department use.
Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use.
Microarray expression profiles reveal substantial changes in gene expression in the ipsilateral dorsal horn of the spinal cord in response to three peripheral nerve injury models of neuropathic pain. ...However, only 54 of the 612 regulated genes are commonly expressed across all the neuropathic pain models. Many of the commonly regulated transcripts are immune related and include the complement components C1q, C3, and C4, which we find are expressed only by microglia. C1q and C4 are, moreover, the most strongly regulated of all 612 regulated genes. In addition, we find that the terminal complement component C5 and the C5a receptor (C5aR) are upregulated in spinal microglia after peripheral nerve injury. Mice null for C5 had reduced neuropathic pain sensitivity, excluding C3a as a pain effector. C6-deficient rats, which cannot form the membrane attack complex, have a normal neuropathic pain phenotype. However, C5a applied intrathecally produces a dose-dependent, slow-onset cold pain in naive animals. Furthermore, a C5aR peptide antagonist reduces cold allodynia in neuropathic pain models. We conclude that induction of the complement cascade in spinal cord microglia after peripheral nerve injury contributes to neuropathic pain through the release and action of the C5a anaphylatoxin peptide.
Gravity waves in the terrestrial atmosphere are a vital geophysical process, acting to transport energy and momentum on a wide range of scales and to couple the various atmospheric layers. Despite ...the importance of these waves, the many studies to date have often exhibited very dissimilar results, and it remains unclear whether these differences are primarily instrumental or methodological. Here, we address this problem by comparing observations made by a diverse range of the most widely used gravity-wave-resolving instruments in a common geographic region around the southern Andes and Drake Passage, an area known to exhibit strong wave activity. Specifically, we use data from three limb-sounding radiometers (Microwave Limb Sounder, MLS-Aura; HIgh Resolution Dynamics Limb Sounder, HIRDLS; Sounding of the Atmosphere using Broadband Emission Radiometry, SABER), the Constellation Observing System for Meteorology, Ionosphere and Climate (COSMIC) GPS-RO constellation, a ground-based meteor radar, the Advanced Infrared Sounder (AIRS) infrared nadir sounder and radiosondes to examine the gravity wave potential energy (GWPE) and vertical wavelengths (λz) of individual gravity-wave packets from the lower troposphere to the edge of the lower thermosphere ( ∼ 100 km). Our results show important similarities and differences. Limb sounder measurements show high intercorrelation, typically > 0.80 between any instrument pair. Meteor radar observations agree in form with the limb sounders, despite vast technical differences. AIRS and radiosonde observations tend to be uncorrelated or anticorrelated with the other data sets, suggesting very different behaviour of the wave field in the different spectral regimes accessed by each instrument. Evidence of wave dissipation is seen, and varies strongly with season. Observed GWPE for individual wave packets exhibits a log-normal distribution, with short-timescale intermittency dominating over a well-repeated monthly-median seasonal cycle. GWPE and λz exhibit strong correlations with the stratospheric winds, but not with local surface winds. Our results provide guidance for interpretation and intercomparison of such data sets in their full context.
The present study reports normative ratings for 200 food and non-food odors. One hundred participants rated odors across measures of verbalisability, perceived descriptive ability, context ...availability, pleasantness, irritability, intensity, familiarity, frequency, age of acquisition, and complexity. Analysis of the agreement between raters revealed that four dimensions, those of familiarity, intensity, pleasantness, and irritability, have the strongest utility as normative data. The ratings for the remaining dimensions exhibited reduced discriminability across the odor set and should therefore be used with caution. Indeed, these dimensions showed a larger difference between individuals in the ratings of the odors. Familiarity was shown to be related to pleasantness, and a non-linear relationship between pleasantness and intensity was observed which reflects greater intensity for odors that elicit a strong hedonic response. The suitability of these data for use in future olfactory study is considered, and effective implementation of the data for controlling stimuli is discussed.
Purpose
To investigate the effects of a supervised combined resistance and aerobic training programme on cardiorespiratory fitness, body composition, insulin resistance and quality of life (QoL) in ...survivors of childhood haematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI).
Participants
HSCT/TBI survivors (n = 20; 8 females). Mean (range) for age at study and time since HSCT/TBI was 16.7 (10.9‐24.5) and 8.4 (2.3‐16.0) years, respectively.
Methods
After a 6‐month run‐in, participants undertook supervised 45‐ to 60‐minute resistance and aerobic training twice weekly for 6 months, with a 6‐month follow‐up. The following assessments were made at 0, 6 (start of exercise programme), 12 (end of exercise programme) and 18 months: Body composition via dual energy X‐ray absorptiometry, homeostatic model assessment of insulin resistance (HOMA‐IR), cardiorespiratory fitness (treadmill‐based peak rate of oxygen uptake (VO2 peak) test), QoL questionnaires (36‐Item Short Form Health Survey (SF‐36) and Minneapolis‐Manchester Quality of Life Instrument (MMQL).
Results
Results expressed as mean (standard deviation) or geometric mean (range). There were significant improvements in VO2 peak (35.7 (8.9) vs 41.7 (16.1) mL/min/kg, P = 0.05), fasted plasma insulin (16.56 (1.48‐72.8) vs 12.62 (1.04‐54.97) mIU/L, P = 0.03) and HOMA‐IR (3.65 (0.30‐17.26) vs 2.72 (0.22‐12.89), P = 0.02) after the exercise intervention. There were also significant improvements in the SF‐36 QoL general health domain (69.7 (14.3) vs 72.7 (16.0), P = 0.001) and the MMQL school domain (69.1 (25.2) vs (79.3 (21.6), P = 0.03) during the exercise intervention. No significant changes were observed in percentage body fat, fat mass or lean mass.
Conclusion
The supervised 6‐month combined resistance and aerobic exercise programme significantly improved cardiorespiratory fitness, insulin resistance and QoL in childhood HSCT/TBI survivors, with no change in body composition, suggesting a metabolic training effect on muscle. These data support a role for targeted physical rehabilitation services in this group at high risk of diabetes and cardiovascular disease.
Abstract
The dominant mode of seasonal variability in the global tropical upper-stratosphere and mesosphere zonal wind is the semiannual oscillation (SAO). However, it is notoriously difficult to ...measure winds at these heights from satellite or ground-based remote sensing. Here, the balance wind relationship is used to derive monthly and zonally averaged zonal winds in the tropics from satellite retrievals of geopotential height. Data from the Aura Microwave Limb Sounder (MLS) cover about 12.5 yr, and those from the Thermosphere, Ionosphere, Mesosphere Energetics and Dynamics (TIMED) Sounding of the Atmosphere Using Broadband Emission Radiometry (SABER) cover almost 15 yr. The derived winds agree with direct wind observations below 10 hPa and above 80 km; there are no direct wind observations for validation in the intervening layers of the middle atmosphere. The derived winds show the following prominent peaks associated with the SAO: easterly maxima near the solstices at 1.0 hPa, westerly maxima near the equinoxes at 0.1 hPa, and easterly maxima near the equinoxes at 0.01 hPa. The magnitudes of these three wind maxima are stronger during the first cycle (January at 1.0 hPa and March at 0.1 and 0.01 hPa). The month and pressure level of the wind maxima shift depending on the phase of the quasi-biennial oscillation (QBO) at 10 hPa. During easterly QBO, the westerly maxima are shifted upward, are about 10 m s−1 stronger, and occur approximately 1 month later than those during the westerly QBO phase.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, ...California, from 2002 to 2008.
We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome. Response was a 50% reduction from baseline and remission a score below 8. Secondary measures were Beck Depression Inventory-II (BDI-II) score, antiretroviral uptake, antiretroviral adherence (measured by unannounced pill count), and HIV-1 RNA viral suppression (< 50 copies/mL).
The intervention reduced depression symptom severity (b = -1.97; 95% confidence interval CI = -0.85, -3.08; P < .001) and increased response (adjusted odds ratio AOR = 2.40; 95% CI = 1.86, 3.10; P < .001) and remission (AOR = 2.97; 95% CI = 1.29, 3.87; P < .001). BDI-II results were similar. We observed no statistically significant differences in secondary HIV outcomes.
Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults, a vulnerable population with multiple barriers to adherence.
The study objective was to determine the prevalence and risk factors for nasal colonization with Staphylococcus aureus and methicillin resistance among the urban poor and to compare antibiotic ...resistance and genetic similarity to concurrently collected clinical isolates of methicillin-resistant S. aureus (MRSA). A population-based community sample of 833 homeless and marginally housed adults were cultured and compared with 363 clinical isolates of MRSA; 22.8% of the urban poor were colonized with S. aureus. Of S. aureus isolates, 12.0% were methicillin resistant. Overall prevalence of MRSA was 2.8%. Significant multivariate risk factors for MRSA were injection drug use (odds ratio OR, 9.7), prior endocarditis (OR, 4.1), and prior hospitalization within 1 year (OR, 2.4). Resistance to antimicrobials other than β-lactams was uncommon. Only 2 individuals (0.24%) with MRSA had no known risk factors. A total of 22 of 23 community MRSA genotypically matched clinical MRSA isolates, with 15 of 23 isolates identical to MRSA clones endemic among hospitalized patients.
Public health debates about providing HIV antiretroviral therapy to impoverished populations have centred on the relationship between adherence and risk of drug resistance. Recent data indicate that ...each antiretroviral therapeutic class has a unique adherence–resistance relationship. Resistance to single protease inhibitor therapy occurs most frequently at moderate to high levels of adherence, resistance to non-nucleoside reverse transcriptase inhibitor therapy occurs at low to moderate levels of adherence, and resistance to ritonavir-boosted protease inhibitor therapy is most likely to occur at middle ranges of adherence. These dynamic relationships should be considered in balancing the individual and public health benefits of therapy.
We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the ...homeless.
We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment.
Almost one fourth of participants (23.1%) had a history of imprisonment. Models that examined lifetime substance use showed cocaine use (odds ratio OR=1.67; 95% confidence interval CI=1.04, 2.70), heroin use (OR=1.51; 95% CI=1.07, 2.12), mental illness (OR=1.41; 95% CI=1.01, 1.96), HIV infection (OR=1.69; 95% CI=1.07, 2.64), and having had more than 100 sexual partners were associated with a history of imprisonment. Models that examined recent substance use showed past-year heroin use (OR = 1.65; 95% CI = 1.14, 2.38) and methamphetamine use (OR=1.49; 95% CI=1.00, 2.21) were associated with lifetime imprisonment. Currently selling drugs also was associated with lifetime imprisonment.
Despite high levels of health risks among all homeless and marginally housed people, the levels among homeless former prisoners were even higher. Efforts to eradicate homelessness also must include the unmet needs of inmates who are released from prison.
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